Provider Demographics
NPI:1629120696
Name:VAUGHN, EDWARD MCDONALD JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:MCDONALD
Last Name:VAUGHN
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:804 STAMPER RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-4379
Mailing Address - Country:US
Mailing Address - Phone:910-232-3875
Mailing Address - Fax:910-323-1355
Practice Address - Street 1:804 STAMPER RD
Practice Address - Street 2:SUITE 101
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-4379
Practice Address - Country:US
Practice Address - Phone:910-232-3875
Practice Address - Fax:910-323-1355
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC4814101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional